<html>
	<head>
		<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
		<title>WHV Application Information</title>
		<link href="./style.css" rel="stylesheet" type="text/css"/>
		<script type="text/javascript" src="./jquery.min.js"></script>
		<script type="text/javascript" src="./whv.js"></script>
	</head>
	<body style="padding:20px">
	<form id="userform" method="post" action="saveWHV.php">
		<div class="section">
			<table width="100%" border="0" cellspacing="0" cellpadding="0" align="center" class="sectBorder">
				<tr>
					<td colspan="4" class="tblHeader">Login Details</td>
				</tr>
				<tr>
					<td class="tblLbl" width="150px">UID:</td>
					<td class="tblData" colspan="3">
						<input type="text" id="userid" name="userid" value="" class="txt_field_70" /> 
						<input type="button" value="Search" class="btnInput" id="btnsearch"/>
						<input type="button" value="Create" class="btnInput" id="btncreate"/>
						<input type="hidden" name="countryId" value="46"/>
					</td>
				</tr>
				<tr>
					<td class="tblLbl" width="150px">User Name:</td>
					<td class="tblData">
						<input type="text" id="username" name="username" value="" class="txt_field_70" />
					</td>
					<td class="tblLbl" width="150px">User Password:</td>
					<td class="tblData">
						<input type="text" id="userpwd" name="userpwd" value="" class="txt_field_70" />
					</td>
				</tr>
			</table>
		</div>
		
		<div class="section">
			<table width="100%" border="0" cellspacing="0" cellpadding="0" align="center" class="sectBorder">
				<tr>
					<td colspan="2" class="tblHeader">User Basic Information</td>
				</tr>
			    <tr>
					<td class="tblLbl" style="width:50%">Family name (as in passport):</td>
					<td class="tblData">
						<input type="text" id="fname" name="fname" value="" class="txt_field_80"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Given name 1 (as in passport):</td>
					<td class="tblData">
						<input type="text" id="gname" name="gname" value="" class="txt_field_80"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Gender:</td>
					<td class="tblData">
						<select id="gender" name="gender">
							<option selected="selected" value="">Select an option</option>
							<option value="M">Male</option>
							<option value="F">Female</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Date of birth:</td>
					<td class="tblData">
						<select id="birthD" name="birthD">
							<option value="">-----</option>
							<option value="1">01</option>
							<option value="2">02</option>
							<option value="3">03</option>
							<option value="4">04</option>
							<option value="5">05</option>
							<option value="6">06</option>
							<option value="7">07</option>
							<option value="8">08</option>
							<option value="9">09</option>
							<option value="10">10</option>
							<option value="11">11</option>
							<option value="12">12</option>
							<option value="13">13</option>
							<option value="14">14</option>
							<option value="15">15</option>
							<option value="16">16</option>
							<option value="17">17</option>
							<option value="18">18</option>
							<option value="19">19</option>
							<option value="20">20</option>
							<option value="21">21</option>
							<option value="22">22</option>
							<option value="23">23</option>
							<option value="24">24</option>
							<option value="25">25</option>
							<option value="26">26</option>
							<option value="27">27</option>
							<option value="28">28</option>
							<option value="29">29</option>
							<option value="30">30</option>
							<option value="31">31</option>
						</select>
						<select id="birthM" name="birthM">
							<option value="">-----</option>
							<option value="1">Jan</option>
							<option value="2">Feb</option>
							<option value="3">Mar</option>
							<option value="4">Apr</option>
							<option value="5">May</option>
							<option value="6">Jun</option>
							<option value="7">Jul</option>
							<option value="8">Aug</option>
							<option value="9">Sep</option>
							<option value="10">Oct</option>
							<option value="11">Nov</option>
							<option value="12">Dec</option>
						</select>
						<select id="birthY" name="birthY">
							<option value="">-----</option>
							<option value="1982">1982</option>
							<option value="1983">1983</option>
							<option value="1984">1984</option>
							<option value="1985">1985</option>
							<option value="1986">1986</option>
							<option value="1987">1987</option>
							<option value="1988">1988</option>
							<option value="1989">1989</option>
							<option value="1990">1990</option>
							<option value="1991">1991</option>
							<option value="1992">1992</option>
							<option value="1993">1993</option>
							<option value="1994">1994</option>
							<option value="1995">1995</option>
							<option value="1996">1996</option>
							<option value="1997">1997</option>
							<option value="1998">1998</option>
							<option value="1999">1999</option>
							<option value="2000">2000</option>
							<option value="2001">2001</option>
							<option value="2002">2002</option>
							<option value="2003">2003</option>
							<option value="2004">2004</option>
							<option value="2005">2005</option>
							<option value="2006">2006</option>
							<option value="2007">2007</option>
							<option value="2008">2008</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Country Of Birth:</td>
					<td class="tblData">
						<select id="countryOfBirth" name="countryOfBirth">
							<option selected="selected" value="">Select an option</option>
							<option value="4">Afghanistan</option>
							<option value="5">Albania</option>
							<option value="6">Algeria</option>
							<option value="7">American Samoa</option>
							<option value="8">Andorra</option>
							<option value="9">Angola</option>
							<option value="10">Anguilla</option>
							<option value="11">Antarctica</option>
							<option value="12">Antigua &amp; Barbuda</option>
							<option value="13">Argentina</option>
							<option value="14">Armenia</option>
							<option value="15">Aruba</option>
							<option value="16">Australia</option>
							<option value="17">Austria</option>
							<option value="18">Azerbaijan</option>
							<option value="19">Bahamas</option>
							<option value="20">Bahrain</option>
							<option value="21">Bangladesh</option>
							<option value="22">Barbados</option>
							<option value="23">Belarus</option>
							<option value="24">Belgium</option>
							<option value="25">Belize</option>
							<option value="26">Benin</option>
							<option value="27">Bermuda</option>
							<option value="28">Bhutan</option>
							<option value="29">Bolivia</option>
							<option value="30">Bosnia &amp; Herzegovina</option>
							<option value="31">Botswana</option>
							<option value="32">Brazil</option>
							<option value="33">British Indian Ocean Territory</option>
							<option value="34">Brunei Darussalam</option>
							<option value="35">Bulgaria</option>
							<option value="36">Burkina Faso</option>
							<option value="37">Burundi</option>
							<option value="38">Cambodia</option>
							<option value="39">Cameroon</option>
							<option value="40">Canada</option>
							<option value="41">Cape Verde</option>
							<option value="42">Cayman Islands</option>
							<option value="43">Central African Republic</option>
							<option value="44">Chad</option>
							<option value="45">Chile</option>
							<option value="46">China</option>
							<option value="47">Christmas Island</option>
							<option value="48">Cocos (Keeling) Island</option>
							<option value="49">Colombia</option>
							<option value="50">Comoros</option>
							<option value="51">Congo</option>
							<option value="52">Cook Islands</option>
							<option value="53">Costa Rica</option>
							<option value="54">Croatia</option>
							<option value="55">Cuba</option>
							<option value="56">Cyprus</option>
							<option value="57">Czech Republic</option>
							<option value="58">Democratic Republic of Congo</option>
							<option value="59">Denmark</option>
							<option value="60">Djibouti</option>
							<option value="61">Dominica</option>
							<option value="62">Dominican Republic</option>
							<option value="63">East Timor</option>
							<option value="64">Ecuador</option>
							<option value="65">Egypt</option>
							<option value="66">El Salvador</option>
							<option value="67">Equitorial Guinea</option>
							<option value="68">Eritrea</option>
							<option value="69">Estonia</option>
							<option value="70">Ethiopia</option>
							<option value="71">Faeroe Islands</option>
							<option value="72">Falkland Islands</option>
							<option value="73">Federated States of Micronesia</option>
							<option value="74">Fiji</option>
							<option value="75">Finland</option>
							<option value="76">France</option>
							<option value="77">French Guiana</option>
							<option value="78">French Polynesia</option>
							<option value="79">Gabon</option>
							<option value="80">Gambia</option>
							<option value="81">Georgia</option>
							<option value="82">Germany</option>
							<option value="83">Ghana</option>
							<option value="84">Gibraltar</option>
							<option value="85">Great Britain</option>
							<option value="86">Greece</option>
							<option value="87">Greenland</option>
							<option value="88">Grenada</option>
							<option value="89">Guadeloupe</option>
							<option value="90">Guam</option>
							<option value="91">Guatemala</option>
							<option value="92">Guinea</option>
							<option value="93">Guinea - Bissau</option>
							<option value="94">Guyana</option>
							<option value="95">Haiti</option>
							<option value="96">Honduras</option>
							<option value="97">Hong Kong</option>
							<option value="98">Hungary</option>
							<option value="99">Iceland</option>
							<option value="100">India</option>
							<option value="101">Indonesia</option>
							<option value="102">Iran</option>
							<option value="103">Iraq</option>
							<option value="104">Ireland</option>
							<option value="105">Israel</option>
							<option value="106">Italy</option>
							<option value="107">Ivory Coast</option>
							<option value="108">Jamaica</option>
							<option value="109">Japan</option>
							<option value="110">Jordan</option>
							<option value="111">Kazakhstan</option>
							<option value="112">Kenya</option>
							<option value="113">Kiribati</option>
							<option value="114">Kosovo - UN Mission in</option>
							<option value="250">Kosovo - Republic of</option>
							<option value="115">Kuwait</option>
							<option value="116">Kyrgyzstan</option>
							<option value="117">Laos</option>
							<option value="118">Latvia</option>
							<option value="119">Lebanon</option>
							<option value="120">Lesotho</option>
							<option value="121">Liberia</option>
							<option value="122">Libya</option>
							<option value="123">Liechtenstein</option>
							<option value="124">Lithuania</option>
							<option value="125">Luxembourg</option>
							<option value="126">Macau</option>
							<option value="127">Macedonia</option>
							<option value="128">Madagascar</option>
							<option value="129">Malawi</option>
							<option value="130">Malaysia</option>
							<option value="131">Maldives</option>
							<option value="132">Mali</option>
							<option value="133">Malta</option>
							<option value="134">Marshall Islands</option>
							<option value="135">Martinique</option>
							<option value="136">Mauritania</option>
							<option value="137">Mauritius</option>
							<option value="138">Mayotte</option>
							<option value="139">Mexico</option>
							<option value="140">Moldova</option>
							<option value="141">Monaco</option>
							<option value="142">Mongolia</option>
							<option value="248">Montenegro</option>
							<option value="143">Montserrat</option>
							<option value="144">Morocco</option>
							<option value="145">Mozambique</option>
							<option value="146">Myanmar</option>
							<option value="147">Namibia</option>
							<option value="148">Nauru</option>
							<option value="149">Nepal</option>
							<option value="150">Netherlands</option>
							<option value="151">Netherlands Antilles</option>
							<option value="152">New Caledonia</option>
							<option value="153">New Zealand</option>
							<option value="154">Nicaragua</option>
							<option value="155">Niger</option>
							<option value="156">Nigeria</option>
							<option value="157">Niue</option>
							<option value="158">Norfolk Island</option>
							<option value="159">North Korea</option>
							<option value="160">Northern Mariana Islands</option>
							<option value="161">Norway</option>
							<option value="162">Oman</option>
							<option value="163">Pacific Island Trust Territory</option>
							<option value="164">Pakistan</option>
							<option value="165">Palau</option>
							<option value="166">Palestine</option>
							<option value="167">Panama</option>
							<option value="168">Papua New Guinea</option>
							<option value="169">Paraguay</option>
							<option value="170">Peru</option>
							<option value="171">Philippines</option>
							<option value="172">Pitcairn Islands</option>
							<option value="173">Poland</option>
							<option value="174">Portugal</option>
							<option value="175">Puerto Rico</option>
							<option value="176">Qatar</option>
							<option value="177">Reunion</option>
							<option value="178">Romania</option>
							<option value="179">Russia</option>
							<option value="180">Rwanda</option>
							<option value="181">Samoa</option>
							<option value="182">San Marino</option>
							<option value="183">Sao Tome &amp; Principe</option>
							<option value="184">Saudi Arabia</option>
							<option value="185">Senegal</option>
							<option value="247">Serbia</option>
							<option value="249">Serbia &amp; Montenegro</option>
							<option value="186">Seychelles</option>
							<option value="187">Sierra Leone</option>
							<option value="188">Singapore</option>
							<option value="189">Slovakia</option>
							<option value="190">Slovenia</option>
							<option value="191">Solomon Islands</option>
							<option value="192">Somalia</option>
							<option value="193">South Africa</option>
							<option value="194">South Korea</option>
							<option value="195">South Pacific commission</option>
							<option value="251">South Sudan</option>
							<option value="196">Soviet Union</option>
							<option value="197">Spain</option>
							<option value="198">Sri Lanka</option>
							<option value="199">St Helena</option>
							<option value="200">St Kitts - Nevis</option>
							<option value="201">St Lucia</option>
							<option value="202">St Pierre &amp; Miquelon</option>
							<option value="203">St Vincent and the Grenadines</option>
							<option value="204">Sth Georgia &amp; Sandwich Islands</option>
							<option value="205">Sudan</option>
							<option value="206">Suriname</option>
							<option value="207">Swaziland</option>
							<option value="208">Sweden</option>
							<option value="209">Switzerland</option>
							<option value="210">Syria</option>
							<option value="211">Taiwan</option>
							<option value="212">Tajikistan</option>
							<option value="213">Tanzania</option>
							<option value="214">Thailand</option>
							<option value="215">Timor Leste</option>
							<option value="216">Togo</option>
							<option value="217">Tokelau</option>
							<option value="218">Tonga</option>
							<option value="219">Trinidad and Tobago</option>
							<option value="220">Tunisia</option>
							<option value="221">Turkemenistan</option>
							<option value="222">Turkey</option>
							<option value="223">Turks and Caicos Islands</option>
							<option value="224">Tuvalu</option>
							<option value="225">Uganda</option>
							<option value="226">Ukraine</option>
							<option value="227">United Arab Emirates</option>
							<option value="228">United Nations</option>
							<option value="229">United States of America</option>
							<option value="230">Uruguay</option>
							<option value="231">US Outlying Islands</option>
							<option value="232">US Pacific Islands</option>
							<option value="233">Uzbekistan</option>
							<option value="234">Vanuatu</option>
							<option value="235">Vatican City</option>
							<option value="236">Venezuela</option>
							<option value="237">Vietnam</option>
							<option value="238">Virgin Islands, British</option>
							<option value="239">Virgin Islands, USA</option>
							<option value="240">Wallis and Futuna</option>
							<option value="241">Western Sahara</option>
							<option value="242">Yemen</option>
							<option value="243">Yugoslavia</option>
							<option value="244">Zambia</option>
							<option value="245">Zimbabwe</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Street</td>
					<td class="tblData">
						<input type="text" id="street" name="street" value="" class="txt_field_80"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">City</td>
					<td class="tblData">
						<input type="text" id="city" name="city" value="" class="txt_field_80"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Email</td>
					<td class="tblData">
						<input type="text" id="email" name="email" value="" class="txt_field_80"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Are you represented by an <a href="http://glossary.immigration.govt.nz/immigrationadviser" target="_blank">immigration adviser</a>?</td>
					<td class="tblData">
						<select id="isAdviser" name="isAdviser">
							<option value="No" selected="selected">No</option>
							<option value="Yes">Yes</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Communication method</td>
					<td class="tblData">
						<select id="commuMethod" name="commuMethod">
							<option selected="selected" value="1">Email</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Do you have a Visa or MasterCard card available for payment?</td>
					<td class="tblData">
						<select id="hasCard" name="hasCard">
							<!-- <option selected="selected" value="">Select an option</option> -->
							<option value="No">No</option>
							<option value="Yes" selected="selected">Yes</option>
						</select>*
					</td>
				</tr>
			</table>
		</div>
		
		<div class="section">
			<table width="100%" border="0" cellspacing="0" cellpadding="0" align="center" class="sectBorder">
				<tr>
					<td colspan="2" class="tblHeader">Passport Details</td>
				</tr>
			    <tr>
					<td class="tblLbl" style="width:50%">Passport Number:</td>
					<td class="tblData" style="width:50%">
						<input type="text" id="passport" name="passport" value="" class="txt_field_80"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl" style="width:50%">Please re-enter Passport Number:</td>
					<td class="tblData" style="width:50%">
						<input type="text" id="repassport" name="repassport" value="" class="txt_field_80"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Passport Expiry Date:</td>
					<td class="tblData">
						<select id="pexpiryD" name="pexpiryD">
							<option value="">-----</option>
							<option value="1">01</option>
							<option value="2">02</option>
							<option value="3">03</option>
							<option value="4">04</option>
							<option value="5">05</option>
							<option value="6">06</option>
							<option value="7">07</option>
							<option value="8">08</option>
							<option value="9">09</option>
							<option value="10">10</option>
							<option value="11">11</option>
							<option value="12">12</option>
							<option value="13">13</option>
							<option value="14">14</option>
							<option value="15">15</option>
							<option value="16">16</option>
							<option value="17">17</option>
							<option value="18">18</option>
							<option value="19">19</option>
							<option value="20">20</option>
							<option value="21">21</option>
							<option value="22">22</option>
							<option value="23">23</option>
							<option value="24">24</option>
							<option value="25">25</option>
							<option value="26">26</option>
							<option value="27">27</option>
							<option value="28">28</option>
							<option value="29">29</option>
							<option value="30">30</option>
							<option value="31">31</option>
						</select>
						<select id="pexpiryM" name="pexpiryM">
							<option value="">-----</option>
							<option value="1">Jan</option>
							<option value="2">Feb</option>
							<option value="3">Mar</option>
							<option value="4">Apr</option>
							<option value="5">May</option>
							<option value="6">Jun</option>
							<option value="7">Jul</option>
							<option value="8">Aug</option>
							<option value="9">Sep</option>
							<option value="10">Oct</option>
							<option value="11">Nov</option>
							<option value="12">Dec</option>
						</select>
						<select id="pexpiryY" name="pexpiryY">
							<option value="">-----</option>
							<option value="2014">2014</option>
							<option value="2015">2015</option>
							<option value="2016">2016</option>
							<option value="2017">2017</option>
							<option value="2018">2018</option>
							<option value="2019">2019</option>
							<option value="2020">2020</option>
							<option value="2021">2021</option>
							<option value="2022">2022</option>
							<option value="2023">2023</option>
							<option value="2024">2024</option>
							<option value="2025">2025</option>
							<option value="2026">2026</option>
							<option value="2027">2027</option>
							<option value="2028">2028</option>
							<option value="2029">2029</option>
							<option value="2030">2030</option>
							<option value="2031">2031</option>
							<option value="2032">2032</option>
							<option value="2033">2033</option>
							<option value="2034">2034</option>
							<option value="2035">2035</option>
							<option value="2036">2036</option>
							<option value="2037">2037</option>
							<option value="2038">2038</option>
						</select>*
					</td>
				</tr>
			</table>
		</div>
		
		<div class="section">
			<table width="100%" border="0" cellspacing="0" cellpadding="0" align="center" class="sectBorder">
				<tr>
					<td colspan="2" class="tblHeader">Second Form of Identification</td>
				</tr>
				<tr>
					<td colspan="2" class="tblData">
					Please enter the details of another Form of Identification you would be able to produce to prove your identity.
					</td>
				</tr>
			    <tr>
					<td class="tblLbl" style="width:50%">Identification Type:</td>
					<td class="tblData" style="width:50%">
						<select id="idType" name="idType">
							<option selected="selected" value="">Select an option</option>
							<option value="1">Driver License</option>
							<option value="2">Birth Certificate</option>
							<option value="3">National ID</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Date Document was Issued:</td>
					<td class="tblData">
						<select id="idIssuedD" name="idIssuedD">
							<option value="">-----</option>
							<option value="1">01</option>
							<option value="2">02</option>
							<option value="3">03</option>
							<option value="4">04</option>
							<option value="5">05</option>
							<option value="6">06</option>
							<option value="7">07</option>
							<option value="8">08</option>
							<option value="9">09</option>
							<option value="10">10</option>
							<option value="11">11</option>
							<option value="12">12</option>
							<option value="13">13</option>
							<option value="14">14</option>
							<option value="15">15</option>
							<option value="16">16</option>
							<option value="17">17</option>
							<option value="18">18</option>
							<option value="19">19</option>
							<option value="20">20</option>
							<option value="21">21</option>
							<option value="22">22</option>
							<option value="23">23</option>
							<option value="24">24</option>
							<option value="25">25</option>
							<option value="26">26</option>
							<option value="27">27</option>
							<option value="28">28</option>
							<option value="29">29</option>
							<option value="30">30</option>
							<option value="31">31</option>
						</select>
						<select id="idIssuedM" name="idIssuedM">
							<option value="">-----</option>
							<option value="1">Jan</option>
							<option value="2">Feb</option>
							<option value="3">Mar</option>
							<option value="4">Apr</option>
							<option value="5">May</option>
							<option value="6">Jun</option>
							<option value="7">Jul</option>
							<option value="8">Aug</option>
							<option value="9">Sep</option>
							<option value="10">Oct</option>
							<option value="11">Nov</option>
							<option value="12">Dec</option>
						</select>
						<select id="idIssuedY" name="idIssuedY">
							<option value="">-----</option>
							<option value="2014">2014</option>
							<option value="2015">2015</option>
							<option value="2016">2016</option>
							<option value="2017">2017</option>
							<option value="2018">2018</option>
							<option value="2019">2019</option>
							<option value="2020">2020</option>
							<option value="2021">2021</option>
							<option value="2022">2022</option>
							<option value="2023">2023</option>
							<option value="2024">2024</option>
							<option value="2025">2025</option>
							<option value="2026">2026</option>
							<option value="2027">2027</option>
							<option value="2028">2028</option>
							<option value="2029">2029</option>
							<option value="2030">2030</option>
							<option value="2031">2031</option>
							<option value="2032">2032</option>
							<option value="2033">2033</option>
							<option value="2034">2034</option>
							<option value="2035">2035</option>
							<option value="2036">2036</option>
							<option value="2037">2037</option>
							<option value="2038">2038</option>
						</select>*
					</td>
				</tr>
			</table>
		</div>
		
		<div class="section">
			<table width="100%" border="0" cellspacing="0" cellpadding="0" align="center" class="sectBorder">
				<tr>
					<td colspan="2" class="tblHeader">Question Details</td>
				</tr>
			    <tr>
					<td colspan="2" class="tblData" style="padding:10px 3px">
						IMPORTANT NOTE - The information you have provided indicates that you are currently residing outside New Zealand. If this information is NOT correct it is essential that you return to the "Personal Details" Screen and change the country you have selected.
					</td>
				</tr>
				<tr>
					<td class="tblLbl" style="width:50%">Have you ever been issued a visa or permit under a New Zealand Working Holiday Scheme before?</td>
					<td class="tblData" style="width:50%">
						<select id="question1" name="question1">
							<option selected="selected" value="">Select an option</option>
							<option value="No">No</option>
							<option value="Yes">Yes</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Do you have sufficient funds available for your Working Holiday in New Zealand? 
			Check the amount of funds you will need </td>
					<td class="tblData">
						<select id="question2" name="question2">
							<option selected="selected" value="">Select an option</option>
							<option value="No">No</option>
							<option value="Yes">Yes</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Please enter the date you intend to travel to New Zealand </td>
					<td class="tblData">
						<select id="q3_date_d" name="q3_date_d">
							<option value="">-----</option>
							<option value="1">01</option>
							<option value="2">02</option>
							<option value="3">03</option>
							<option value="4">04</option>
							<option value="5">05</option>
							<option value="6">06</option>
							<option value="7">07</option>
							<option value="8">08</option>
							<option value="9">09</option>
							<option value="10">10</option>
							<option value="11">11</option>
							<option value="12">12</option>
							<option value="13">13</option>
							<option value="14">14</option>
							<option value="15">15</option>
							<option value="16">16</option>
							<option value="17">17</option>
							<option value="18">18</option>
							<option value="19">19</option>
							<option value="20">20</option>
							<option value="21">21</option>
							<option value="22">22</option>
							<option value="23">23</option>
							<option value="24">24</option>
							<option value="25">25</option>
							<option value="26">26</option>
							<option value="27">27</option>
							<option value="28">28</option>
							<option value="29">29</option>
							<option value="30">30</option>
							<option value="31">31</option>
						</select>
						<select id="q3_date_m" name="q3_date_m">
							<option value="">-----</option>
							<option value="1">Jan</option>
							<option value="2">Feb</option>
							<option value="3">Mar</option>
							<option value="4">Apr</option>
							<option value="5">May</option>
							<option value="6">Jun</option>
							<option value="7">Jul</option>
							<option value="8">Aug</option>
							<option value="9">Sep</option>
							<option value="10">Oct</option>
							<option value="11">Nov</option>
							<option value="12">Dec</option>
						</select>
						<select id="q3_date_y" name="q3_date_y">
							<option value="">-----</option>
							<option value="2014">2014</option>
							<option value="2015">2015</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Have you been to NZ before? </td>
					<td class="tblData">
						<select id="question4" name="question4">
							<option value="No" selected="selected">No</option>
							<option value="Yes">Yes</option>
						</select>
					</td>
				</tr>
				<tr>
					<td class="tblLbl">	If yes, when? </td>
					<td class="tblData">
						<select id="q5_date_d" name="q5_date_d">
							<option value="">-----</option>
							<option value="1">01</option>
							<option value="2">02</option>
							<option value="3">03</option>
							<option value="4">04</option>
							<option value="5">05</option>
							<option value="6">06</option>
							<option value="7">07</option>
							<option value="8">08</option>
							<option value="9">09</option>
							<option value="10">10</option>
							<option value="11">11</option>
							<option value="12">12</option>
							<option value="13">13</option>
							<option value="14">14</option>
							<option value="15">15</option>
							<option value="16">16</option>
							<option value="17">17</option>
							<option value="18">18</option>
							<option value="19">19</option>
							<option value="20">20</option>
							<option value="21">21</option>
							<option value="22">22</option>
							<option value="23">23</option>
							<option value="24">24</option>
							<option value="25">25</option>
							<option value="26">26</option>
							<option value="27">27</option>
							<option value="28">28</option>
							<option value="29">29</option>
							<option value="30">30</option>
							<option value="31">31</option>
						</select>
						<select id="q5_date_m" name="q5_date_m">
							<option value="">-----</option>
							<option value="1">Jan</option>
							<option value="2">Feb</option>
							<option value="3">Mar</option>
							<option value="4">Apr</option>
							<option value="5">May</option>
							<option value="6">Jun</option>
							<option value="7">Jul</option>
							<option value="8">Aug</option>
							<option value="9">Sep</option>
							<option value="10">Oct</option>
							<option value="11">Nov</option>
							<option value="12">Dec</option>
						</select>
						<select id="q5_date_y" name="q5_date_y">
							<option value="">-----</option>
							<option value="2001">2001</option>
							<option value="2002">2002</option>
							<option value="2003">2003</option>
							<option value="2004">2004</option>
							<option value="2005">2005</option>
							<option value="2006">2006</option>
							<option value="2007">2007</option>
							<option value="2008">2008</option>
							<option value="2009">2009</option>
							<option value="2010">2010</option>
							<option value="2011">2011</option>
							<option value="2012">2012</option>
							<option value="2013">2013</option>
							<option value="2014">2014</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Do you have sufficient funds to purchase an outward ticket when you are due to leave New Zealand? </td>
					<td class="tblData">
						<select id="question6" name="question6">
							<option value="No">No</option>
							<option value="Yes" selected="selected">Yes</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Do you meet the <a href="http://formshelp.immigration.govt.nz/onlineservices/whsonline/specialcountry" target="_blank">specific 
				requirements</a> for the scheme you are applying for?</td>
					<td class="tblData">
						<select id="question7" name="question7">
							<option>Select an option</option>
							<option value="No">No</option>
							<option value="Yes" selected="selected">Yes</option>
						</select>*
					</td>
				</tr>
			</table>
		</div>
		
		<!-- <div class="section">
			<table width="100%" border="0" cellspacing="0" cellpadding="0" align="center" class="sectBorder">
				<tr>
					<td colspan="2" class="tblHeader">Payer Details</td>
				</tr>
				<tr>
					<td class="tblLbl" style="width:50%">Payer Name</td>
					<td class="tblData" style="width:50%">
						<input type="text" id="payername" name="payername" value="" class="txt_field_70"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Select your preferred payment method </td>
					<td class="tblData">
						<select id="card_type_id" name="card_type_id">
							<option selected="selected" value="">Select an option</option>
							<option value="card_type_VISA">VISA</option>
							<option value="card_type_MASTERCARD">MASTERCARD</option>
						</select>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Card Number: </td>
					<td class="tblData">
						<input type="text" id="cardnumber" name="cardnumber" value="" class="txt_field_70"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Card Code: </td>
					<td class="tblData">
						<input type="text" id="cardcode" name="cardcode" value="" class="txt_field_70"/>*
					</td>
				</tr>
				<tr>
					<td class="tblLbl">Expiry Date: </td>
					<td class="tblData">
						<select id="c_expiry_m" name="c_expiry_m">
							<option value="">-----</option>
							<option value="1">01</option>
							<option value="2">02</option>
							<option value="3">03</option>
							<option value="4">04</option>
							<option value="5">05</option>
							<option value="6">06</option>
							<option value="7">07</option>
							<option value="8">08</option>
							<option value="9">09</option>
							<option value="10">10</option>
							<option value="11">11</option>
							<option value="12">12</option>
						</select>
						<select id="c_expiry_y" name="c_expiry_y">
							<option value="">-----</option>
							<option value="2013">2013</option>
							<option value="2014">2014</option>
							<option value="2015">2015</option>
							<option value="2016">2016</option>
							<option value="2017">2017</option>
							<option value="2018">2018</option>
							<option value="2019">2019</option>
							<option value="2020">2020</option>
							<option value="2021">2021</option>
							<option value="2022">2022</option>
							<option value="2023">2023</option>
							<option value="2024">2024</option>
							<option value="2025">2025</option>
							<option value="2026">2026</option>
							<option value="2027">2027</option>  
						</select>
					</td>
				</tr>
			</table>
		</div> -->
		
		<div class="section">
		<input type="button" value="Save" class="btnInput" id="btnsave"/>
		</div>
		</form>
	</body>
</html>


